Mindfulness in Depression Relapse Prevention – The Body Scan

I’m taking part in a research study for CAMH into the efficacy of mindfulness in preventing depression relapse. The study comprises eight weekly sessions and in this post I’ll cover Session 2, and the daily practices for the following week. Use the links at the end to access posts on Session 1 and more on the background and premise of the study.

After a week of practicing mindfulness in short routine tasks, Session 2 introduced a more formal exercise, designed to help me connect with direct, immediate body sensations as a way of focusing my attention away from past or future preoccupations.

Time to get serious…

The Body Scan gets you to focus the “spotlight of awareness” on each area of the body at a time, and investigate what you feel there. It’s a mix of feeling and visualisation. I found it easiest to do this lying down. You need somewhere quiet where you won’t be disturbed and since this is an impossibility in the face of my children’s curiosity, despite their best intentions, I chose to do it in the evening, when they were all in bed.

Settling into a comfortable position and closing my eyes, I let the audio guide talk me through. I was advised to form an intention to do the exercise in an unrushed and deliberate manner and to view it as a way of caring for my body – a kindness to myself. The description of my attention as a “spotlight of awareness” really helped me visualise it focused on one area at a time. The exercise also incorporated breathing, using it as a way of focusing the attention, and as a means of intentionally moving that attention to the next area.

After focusing on my breath to centre my mind on my body, I took my attention, on an out-breath, down my left leg to the toes of the left foot. There, I shone the “spotlight of awareness” on them and the visualisation was so powerful I felt a warming sensation as I imagined them bathed in a beam of light. Keeping my attention focused on those toes, I tried to become aware of any feelings I found there: whether could I feel my toes touching one another, if they felt warm/cool/damp/dry, could they feel air currents/draughts, any aches or discomfort, etc. At the same time I tried to keep my mind in a state of alert investigation. When it wandered, and it did – many times, I acknowledged that it had, and calmly drew it back to the task without judgement or reproach.

Releasing the toes from the spotlight, I expanded my awareness to the whole foot, investigating it methodically – heel, instep, arch, upper surface and ankles; all the time trying to focus and bringing my mind back to that focus when it strayed. In this way, I conducted an inventory of my bodily sensations, moving from the left foot to the calf, to the knee, to the thigh, up to the left hip, then across the pelvis and down to the toes of the right foot, repeating the process up my right leg to the right hip, and into the pelvis, genitals and buttocks. I tried to picture the bones, muscles, ligaments and tendons and found it helped my focus, and limited my distraction, to have my own internal commentary during the silences on the audio.

I made every shift of attention to another area on an out-breath. Moving up the body, I took my awareness to the lower torso, letting it rest there and becoming aware of the rise and fall of my abdomen while breathing, the movement of my chest as my lungs expanded and contracted, the tension of clothes tightening over skin. I tried, at all times, to have an alert curiosity about what I was doing.

I moved my attention around 180 degrees to my back – feeling pressure points, tension aches and the cushioning softness of the surface I lay on – examining the large muscles there, the spine and the shoulder-blades, before releasing them from my mind’s eye and moving my awareness down both arms simultaneously, past the biceps, elbows and forearms, allowing it to settle in the hands and fingers. On an exhale, I moved the focus back up my arms to my neck, allowing it to rest there, in the vocal cords, throat and spinal cord – before moving my attention to the skull, focusing first on the lower face, imagining the slackness of my jaw and noting any sensations of tightness or pulling. Then moving around to the ears, the scalp, the back of the head before coming around to the front, noting the muscles around the eyes and brows and ultimately up to the crown of the head, resting there before moving back down into the body and finally, trying to be aware of the body as a whole – one whole breath; one whole body.

How can it help?

The duration of the audio guide was thirty-three minutes and I passed a lot of them bringing my mind back to refocus on the task in hand. But that’s an integral part of using body awareness to build up our “mindfulness muscles”. Awareness of the body can help us identify emotions, which, you may not realise, manifest themselves physically. Think of slumped shoulders when sad or furrowed brows when puzzled and you’ll see the connection. The body scan provides a different way to respond to these negative emotions; instead of trying to “think” your way out, you shift the centre of attention from what’s going on in your head to what’s going on in your body. But it’s more than just a distraction technique. It also helps you to face negative sensations; breathing into discomfort and examining it instead of running from it, or making a conscious choice to do something to alleviate it.

The ABC Model of Emotional Distress

I’m slowly learning to separate my thoughts from my feelings and to see the differences between the two.

We superimpose all kinds of things onto any situation; we imbue people with thoughts they don’t have and imagine conversations that never took place. It doesn’t make any of them true, yet we build up our story, populating it with more characters and giving it deeper layers. It’s no wonder we get hooked.

The ABC Model of Emotional Distress teaches you to see your thoughts clearly, as part of a changing process. They are the mind’s on-going commentary and they DO influence how you feel.

        Most aware of…                      Not so obvious…                   Most aware of…

Becoming aware of how we classify “pleasant” or “unpleasant” and seeing how our thoughts contribute to these interpretations takes practice. So my daily home practice for the next week was to complete one routine activity mindfully, one body scan and log one pleasant experience – noting any moods or feelings, and any thoughts I had when I wrote it down later. It would be an intensive week. The body scan in itself was a big daily commitment and we were advised to set aside time for it in advance rather than waiting for an opportunity to “squeeze it in”.

So, how did I get on?

There’s no denying it – mindfulness is difficult. I’ve become adept at ignoring/suppressing my thoughts and feelings to the point that I no longer notice them. These exercises required me to re-establish the link and I found I didn’t know where to start. My first clue that I was in trouble came from the Awareness of Pleasant Experiences log. I found I felt flashes of intense joy (at seeing all my children playing nicely together, for example) but aside from those brief moments of bubbling euphoria (which didn’t happen every day, by the way!) I had trouble noticing daily pleasurable experiences. It was as though I couldn’t “hear” happiness unless the volume was on full! I started to see how mindfulness could change my perception and affect my experience of everyday life. I made a conscious effort to notice things that were good – they didn’t have to be ground-breaking, just things that made me feel positive, like the satisfaction of completing a good piece of writing, or the contentment of seeing my sleeping children. I took a moment to acknowledge and enjoy them.

The Body Scan was a tough gig too. At first, I was aware of sensations in every other part of my body apart from where I was focusing! Or large parts of my body felt blank, no feeling whatsoever. Even when I could focus, it was only fleeting, before my mind would be off again, heading somewhere else. I lost count of the number of times I had to bring it back. Self-doubt crept in: “I should be better at this by now,” “maybe there’s something wrong with my mind,” ”maybe I have a problem concentrating.” There were a couple of times when I thought, “This will take aaaages!” and almost fast-forwarded ahead in my mind. Oh, and I did fall asleep in a couple of sessions.

But I stuck with it, eventually ditching the audio – it paused for too long in some parts, causing my mind to drift, and not long enough in others; it was invaluable in helping me plumb the depths of the experience but eventually I needed something more tailored to Me. I performed my own internal commentary and slowly became aware of more sensations; my clothes on my skin, signals from the tiny hairs on the surface of my body. I felt the chill on the edges of my nostrils on an in-breath and the subsequent warmth of the out-breath, and those tiny alerts that prompt you to make a minute adjustment to stay comfortable; a slight move of the head or shrug of the shoulder.

By the end of the week, I felt I’d made progress, and more importantly, mindfulness was becoming a bigger part of my daily life. I found myself choosing to do more things mindfully, as my familiarity with this new tool increased. The challenge will come in applying it to a situation where habit and autopilot take over.

Next week: I explore which different form of mindfulness works best for me – still or moving…

Related Links:

Research into the prevention of depression relapse
Mindfulness in Depression Relapse Prevention – 1: autopilot & raisins

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